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Cost-effectiveness analysis of tobacco dependence treatment in the Czech Republic

Auhtors: Karbusická M., Kolek M., Vothová P., Duba J., Králíková E., Rublee D., Dolečková J.
OBJECTIVES: There is no option of smoking cessation treatment reimbursed by public healthcare payers in the Czech Republic, except for small contributions paid by preventive funds of some health insurance companies. Tobacco dependence is a chronic, relapsing and lethal disease. Smoking harms nearly all organs in the body, causes many comorbidities and generally deteriorates health. The aim of this study is to compare costs and effectiveness of different treatment methods of tobacco dependence used in the Czech Republic from the perspective of the public healthcare payer.
METHODS: Discrete Event Simulation (DES) model developed in ARENA® was used to compare varenicline, bupropion and nicotine replacement therapy (NRT) as pharmacotherapy for tobacco dependence. The evaluation group (100% intervention followed by treatment mix) was compared with treatment mix excluding evaluation product. The model simulates smokers one by one depending on the baseline characteristics. Treatment response, duration of abstinence, time to next quit attempt or relapse is assigned individually to subjects using regression equations. Every subject is assigned an individual risk of developing smokingrelated conditions based on smoking status (smoker or former smoker). Chronic obstructive pulmonary disease, myocardial infarction, stroke and lung cancer were considered as smokingrelated conditions. Incidence of smokingrelated conditions leads higher mortality, lower quality of life and also to higher costs. DES models the benefits of smoking cessation in terms of reducing the risk of smokingrelated conditions and thus higher gain of QALYs and lower costs.
RESULTS: The ICER of varenicline, bupropion and NRT compared to the currently used treatment mix reached 1,229.74 €, 1,586.06 € and 3,572.23 € per QALY gained respectively.
CONCLUSIONS: Varenicline generates the most QALYs and results in the largest cost savings compared to other interventions. Therefore, varenicline can be considered the most costeffective smoking cessation treatment in the Czech Republic.

Presented at the ISPOR 18th Annual European Congress, 7-11 November 2015, MiCo - Milano Congressi in Milan, Italy (PRS49).